Bipolar depression is similar to major depression. A person may lose interest in the activities they enjoyed and feel persistently down, empty, hopeless, or worthless.

If the depression is severe, the person may have thoughts of self-harm or suicide. However, unlike with major depression, people with bipolar depression can also experience mania, which causes feelings of joy and euphoria.

Read on to learn more about bipolar depression, including how it differs from major depression, the symptoms, the types, and how to seek help.

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Bipolar depression is similar to other types of depression. It causes a person to feel persistently low or lacking in energy. This may come with intense feelings of guilt, worthlessness, or sadness.

More than half of people with bipolar depression also experience anhedonia, which is the inability to experience pleasure. They may lose interest or motivation in things they usually enjoy, such as hobbies or other activities.

There is no single characteristic that distinguishes bipolar depression from other types of depression. In fact, many people with bipolar disorder initially think they have depression, and clinicians may misdiagnose them.

Instead of looking at depression symptoms when distinguishing bipolar depression from major depression, it is helpful to look at mood cycling.

Both major depression and bipolar depression can get better and then worse over time. But bipolar disorder causes distinct cycles in mood that change from depression to mania. In some people, the mania may be milder — this is known as hypomania.

In bipolar disorder, each change in mood usually lasts 1–2 weeks or sometimes longer. Depressive episodes may cause:

  • low energy
  • feelings of guilt, hopelessness, or worthlessness
  • difficulty concentrating or remembering
  • slowed movement or speech
  • changes in appetite
  • changes in sleep, such as getting too much or too little
  • loss of libido

In contrast, manic episodes may cause:

  • high energy
  • feelings of extreme happiness or joy
  • a sense of being unusually important, talented, or powerful
  • excessive talking about different topics
  • racing thoughts
  • jumpiness or irritability
  • impulsive behavior
  • increased appetite for food, sex, or pleasurable activities
  • decreased need for sleep

To qualify for a bipolar disorder diagnosis, a person must meet the criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR). This means they must have had:

  • at least one manic or hypomanic episode
  • at least one depressive episode
  • cycles that vary from depression to mania, with each state lasting several days or weeks

Typically, people with the condition have at least two cycles of depression and mania per year, but some people have rapid cycling bipolar, which may cause four or more cycles annually.

Researchers have identified several types of bipolar disorder, with each affecting mood in different ways. The types in the DSM-5-TR include:

  • Bipolar I: This means a person has had at least one manic episode, with or without a depressive episode.
  • Bipolar II: This means a person has had at least one hypomanic episode and at least one depressive episode. Because hypomania is more subtle, a person may notice the depression more than the hypomania.
  • Cyclothymic disorder: This type involves cycles in mood, but they do not fully meet the criteria for depression or mania.
  • Specified bipolar and related disorders: This refers to other disorders that are similar to bipolar but do not meet diagnostic criteria because the episodes are too short or not severe enough.
  • Unspecified bipolar and related disorders: This means a person has symptoms that are clinically significant but do not meet diagnostic criteria for any other bipolar disorder.

Researchers do not fully understand what causes bipolar disorder, or bipolar depression. It may occur due to an interaction between genetics, environment, and biological factors.

Genetics play a strong role in bipolar disorder. Researchers have identified 30 genes with links to the condition.

Imaging scans have also shown structural and chemical differences in the brains of people with bipolar disorder, but the origin of these differences is not clear.

Previous research suggests that at least 60% of adults with bipolar disorder report experiencing at least one stressful event in the months before a manic or depressive episode. Some of the life events that have associations with the development of bipolar disorder include:

  • early parental loss
  • childhood abuse or neglect
  • divorce
  • unemployment
  • childbirth

However, research has not established that stress or trauma directly cause the onset of bipolar disorder or its mood cycles.

It may be that stress and other environmental factors trigger the development of bipolar disorder in people who are genetically vulnerable to it.

The first-line treatment for bipolar disorder is mood-stabilizing medication. These can help prevent mood cycling in general, but in some cases, depression can still occur. This is known as a “breakthrough episode.” If this happens, doctors may prescribe an additional treatment for the depressive symptoms.

Researchers have not discovered a bipolar-specific depression treatment that works for all people. Some people may need to try several different combinations to find one that works for them.

In some cases, doctors may recommend a combination of a mood stabilizer and an antidepressant. However, people with bipolar disorder should not take antidepressants on their own. These drugs are well-researched as a treatment for depression symptoms, but in bipolar disorder, they can contribute to mania.

Other aspects of treatment for bipolar depression can include:

  • monitoring for suicidal thoughts or self-harm
  • psychotherapy
  • lifestyle changes such as regular exercise, reducing alcohol consumption, and controlling or minimizing known triggers

In people with severe mania, doctors may consider electroconvulsive therapy (ECT) as a treatment.

It is important to discuss the risks and benefits of the treatment options with a doctor.

A person should contact a doctor or therapist if they have any depression symptoms. Even if it is not the result of bipolar disorder, a persistent low mood can be a sign of another condition that requires treatment.

People should speak with a doctor as soon as possible if:

  • their treatment is not working
  • they still experience severe depressive episodes
  • they develop side effects or new symptoms
  • their usual symptoms or mood cycles worsen
  • they have thoughts of self-harm or suicide

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects if it’s safe to do so.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Find more links and local resources.

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Bipolar depression is similar to major depression. It can cause feelings of sadness, guilt, apathy, or worthlessness, as well as physical symptoms.

However, bipolar disorder itself is very different from major depression because it is part of a different complex of symptoms. People with bipolar disorder experience distinct periods of depression or mania, or both.

Anyone with potential symptoms of depression should tell their doctor or therapist about all symptoms they experience. Even subtle differences in symptoms may play an important role in getting the right diagnosis and treatment.